Cardiovascular disease (CVD) kills more Americans every year than any other cause of death and the highest rates of mortality from CVD are in the poorest areas of the country. African- Americans (AAs) have a 4.6-fold higher risk of death from CVD than Whites, largely due to uncontrolled hypertension (HTN) and possibly genetic influences. AAs have lower rates of adherence than Whites to HTN treatment but the reasons for this are unknown. An understanding of AAs'perceptions of adherence to HTN treatment and genetic risk factors could be useful in developing tailored, culturally sensitive interventions to improve adherence to treatments and reduce the devastating complications of CVD. Few studies, however, have focused on AAs'perceptions of adherence to HTN treatment. The objective of this study therefore is to gain a better understanding of poor AAs'perceptions of HTN, adherence to treatment, and facilitators and barriers to treatment. Specific aims are to: 1) examine male and female AAs'perceptions of HTN and the ways in which their perceptions influence adherence decisions, 2) examine the influences of AA culture and family history on HTN adherence decisions, and 3) examine the feasibility of developing a CVD genogram for AAs in primary care. Focused ethnography will be used to examine AAs'perceptions of adherence to treatment for HTN and surrounding issues. Thirty participants (15 of each gender) will be recruited from a clinic that provides free medications in Pulaski County, Arkansas. Information on current medications and clinician recommended lifestyle changes will be obtained from participants'medical records. Demographic data will be obtained as well as a self-reported family history, and individual, semi-structured interviews will be conducted with all participants. Also, a CVD genogram will be developed for each participant. Content analysis and constant comparison will be used to examine issues surrounding HTN, and factors influencing adherence to HTN treatment in AA males and females. This study will provide the foundation for the development of culturally sensitive tailored interventions to reduce CVD in this high-risk group. PUBLIC HEALTH RELEVANCE: This research will help health care professionals learn what it is like for poor African-Americans to be treated for high blood pressure. Findings will help us develop culturally sensitive interventions to treat high blood pressure more effectively in African-Americans and thus reduce cardiovascular disease.